ABSTRACT
OBJECTIVES: Colorectal cancer (CRC) is the third most common cancer. Many countries in Europe have already implemented systematic screening programmes as per the recommendations by the European Union. The impact of screening is highly dependent on participation rates. The aim of the study was to identify barriers, facilitators and modifiers to participation in systematised, stool sample-based, publicly financed CRC screening programmes. STUDY DESIGN: Systematic review. METHODS: A systematic search in PubMed, Embase, MEDLINE, CINAHL, Cochrane CENTRAL, Google Scholar and PsycINFO was undertaken. We included both qualitative and quantitative studies reporting on barriers and facilitators (excluding sociodemographic variables) to participation in stool sample-based CRC screening. Barriers and facilitators to participation were summarised and analysed. RESULTS: The inclusion criteria were met in 21 studies. Reported barriers and facilitators were categorised into the following seven themes (examples): psychology (fear of cancer), religion (believing cancer is the will of God), logistics (not knowing how to conduct the test), health-related factors (mental health), knowledge and awareness (lack of knowledge about the test), role of the general practitioner (being supported in taking the test by the general practitioner), and environmental factors (knowing someone who has participated in a screening programme). Six studies reported that non-participation was not due to a negative attitude towards screening for CRC. CONCLUSION: Many barriers to screening were found. It is important to work with peoples' fear of screening. Moreover, this review suggests that it might be possible to increase participation rates, if the population-wide awareness and knowledge of potential health benefits of CRC screening are increased and proper logistical support is provided.
Subject(s)
Colorectal Neoplasms/diagnosis , Early Detection of Cancer/psychology , Health Knowledge, Attitudes, Practice , Mass Screening/psychology , Patient Compliance/psychology , Patient Participation/psychology , Attitude to Health , Fear , Female , Health Services Accessibility , Humans , Intention , Male , Mental Health , Patient Acceptance of Health Care , Practice Patterns, Physicians' , Social SupportABSTRACT
BACKGROUND: Mesh repair of umbilical hernia has been associated with a reduced recurrence rate compared with suture closure, but potentially at the expense of increased postoperative complications and chronic pain. The objective of this systematic review and meta-analysis was to examine the outcomes after elective open mesh and suture repair for umbilical hernia in adults. METHODS: A literature search was conducted to identify studies presenting original data on elective open mesh and suture repair of umbilical hernia. The primary outcome was hernia recurrence. Secondary outcomes included surgical-site infection (SSI), seroma, haematoma and chronic pain. Meta-analyses were undertaken. RESULTS: The search resulted in 5353 hits and led to 14 studies being included (6 RCTs and 8 observational studies) describing a total of 2361 patients. Compared with suture, mesh repair was associated with a lower risk of recurrence (risk ratio (RR) 0·48, 95 per cent c.i. 0·30 to 0·77), with number needed to treat 19 (95 per cent c.i. 14 to 31). Mesh repair was associated with a higher risk of seroma (RR 2·37, 1·45 to 3·87), with number needed to harm 30 (17 to 86). There was no significant difference in the risk of SSI, haematoma or chronic pain. CONCLUSION: The use of mesh in elective repair of umbilical hernia reduced the risk of recurrence compared with suture closure without altering the risk of chronic pain.
ANTECEDENTES: La reparación con malla de la hernia umbilical se ha asociado con una tasa menor de recidivas en comparación con el cierre con suturas, pero potencialmente a expensas de un aumento de complicaciones postoperatorias y dolor crónico. El objetivo de esta revisión sistemática y metaanálisis fue examinar los resultados después de reparación abierta electiva con malla o suturas para la reparación de una hernia umbilical en adultos. MÉTODOS: Se llevó a cabo una búsqueda en la literatura para identificar estudios que presentaban datos originales sobre la reparación abierta electiva con malla y sutura de la hernia umbilical. El resultado primario fue la recidiva herniaria. Los resultados secundarios incluyeron la infección del sitio quirúrgico (surgical site infection, SSI), seroma, hematoma y dolor crónico. Se realizaron metaanálisis. RESULTADOS: En la búsqueda identificaron 5.353 documentos, incluyéndose 14 estudios (6 ensayos clínicos aleatorizados, 8 estudios observacionales) que presentaban datos de un total de 2.361 pacientes. En comparación con la sutura, la reparación con malla se asoció con un menor riesgo de recidiva (tasa de riesgo, risk ratio, RR 0,48, i.c. del 95% 0,30 a 0,77) y número necesario para tratar de 19 (i.c. del 95% 14 a 31). La reparación con malla se asoció con un mayor riesgo de seroma (RR 2,37, i.c. del 95% 1,45 a 3,87) y número necesario para provocar daño de 30 (i.c. del 95% 17 a 86). No hubo diferencia significativa en el riesgo de SSI, hematoma o dolor crónico. CONCLUSIÓN: El uso de malla en la reparación electiva de la hernia umbilical redujo el riesgo de recidiva en comparación con el cierre con sutura, sin modificar el riesgo de dolor crónico.
Subject(s)
Elective Surgical Procedures/methods , Hernia, Umbilical/surgery , Surgical Mesh , Surgical Wound Infection/etiology , Suture Techniques , Chronic Pain/etiology , Elective Surgical Procedures/adverse effects , Hematoma/etiology , Herniorrhaphy/adverse effects , Humans , Recurrence , Seroma/etiologyABSTRACT
The binding of cadmium(II) to human serum transferrin in 0.01 M N-(2-hydroxyethyl)-piperazine-N'-2-ethanesulfonic acid with 5 mM bicarbonate at 25 degrees C has been evaluated by difference ultraviolet spectroscopy. Equilibrium constants were determined by competition versus three different low molecular weight chelating agents: nitrilotriacetic acid, ethylenediamine-N,N'-diacetic acid, and triethylenetetramine. Conditional equilibrium constants for the sequential binding of two cadmium ions to transferrin under the stated experimental conditions are log K1 = 5.95 +/- 0.10 and log K2 = 4.86 +/- 0.13. A linear free energy relationship for the complexation of cadmium and zinc has been prepared by using equilibrium data on 243 complexes of these metal ions with low molecular weight ligands. The transferrin binding constants for cadmium and zinc are in good agreement with this linear free energy relationship. This indicates that the larger size of the cadmium(II) ion does not significantly hinder its binding to the protein.